Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany.
Eur J Cardiothorac Surg. 2024 Mar 29;65(4). doi: 10.1093/ejcts/ezae126.
Myocardial recovery in children supported by a durable left ventricular assist device is a rare, but highly desirable outcome because it could potentially eliminate the need for a cardiac transplant and the lifelong need for immunosuppressant therapy and the risk of complications. However, experience with this specific outcome is extremely limited.
All patients < 19 years old supported by a durable left ventricular assist device from the European Registry for Patients with Mechanical Circulatory Support database were included. Participating centres were approached for additional follow-up data after explantation. Associated factors for explantation due to myocardial recovery were explored using Cox proportional hazard models.
The incidence of recovery in children supported by a durable left ventricular assist device was 11.7% (52/445; median duration of support, 122.0 days). Multivariable analyses showed body surface area (hazard ratio 0.229; confidence interval 0.093-0.565; P = 0.001) and a primary diagnosis of myocarditis (hazard ratio 4.597; confidence interval 2.545-8.303; P < 0.001) to be associated with recovery. Left ventricular end-diastolic diameter in children with myocarditis was not associated with recovery. Follow-up after recovery was obtained for 46 patients (88.5%). Sustained myocardial recovery was reported in 33/46 (71.7%) at the end of the follow-up period (28/33; >2 year). Transplants were performed in 6/46 (11.4%) (in 5 after a ventricular assist device was reimplanted). Death occurred in 7/46 (15.2%).
Myocardial recovery occurs in a substantial portion of paediatric patients supported with durable left ventricular assist devices, and sustainable recovery is seen in around three-quarters of them. Even children with severely dilated ventricles due to myocarditis can show recovery. Clinicians should be attentive to (developing) myocardial recovery. These results can be used to develop internationally approved paediatric weaning guidelines.
在接受耐用型左心室辅助装置支持的儿童中，心肌恢复是一种罕见但非常理想的结果，因为它可能消除心脏移植和终身免疫抑制治疗的需要，以及并发症的风险。然而，对于这种特定结果的经验极其有限。
纳入了来自欧洲机械循环支持患者登记数据库中接受耐用型左心室辅助装置支持的<19 岁的所有患者。在装置移除后，向参与中心询问了额外的随访数据。使用 Cox 比例风险模型探讨了因心肌恢复而移除装置的相关因素。
在接受耐用型左心室辅助装置支持的儿童中，恢复的发生率为 11.7%（52/445；中位支持时间为 122.0 天）。多变量分析显示，体表面积（风险比 0.229；置信区间 0.093-0.565；P=0.001）和原发性心肌炎诊断（风险比 4.597；置信区间 2.545-8.303；P<0.001）与恢复相关。心肌炎患儿的左心室舒张末期直径与恢复无关。对 46 例（88.5%）患儿进行了恢复后的随访。在随访结束时，33/46 例（71.7%）报告持续的心肌恢复（28/33；>2 年）。在 46 例患儿中，6 例（11.4%）进行了移植（5 例在再次植入心室辅助装置后进行）。7 例（15.2%）死亡。
在接受耐用型左心室辅助装置支持的儿童中，相当一部分患儿出现了心肌恢复，其中约四分之三患儿出现了可持续的恢复。即使是因心肌炎导致心室严重扩张的患儿也可能出现恢复。临床医生应注意（出现）心肌恢复。这些结果可用于制定国际认可的儿科撤机指南。
